Pharm Exam 4 Questions
Nurse is teaching the family of a client who has Alzheimer's disease about donepezil. Which of the following information should the nurse include in the teaching? A. "Syncope episodes may occur when taking this medication." B. "This medication may cause tachycardia." C. "You should administer the medication each morning." D. "You will need to monitor for constipation."
A. "Syncope episodes may occur when taking this medication." The nurse should inform the family to monitor for syncope, which places the client at risk for falling.
Patient drinks 5-6 alcoholic beverages per day and takes acetaminophen [Tylenol] for pain relief. The nurse should caution patient to do what? A. Limit intake of acetaminophen to less than 2000mg/day B. Avoid taking acetaminophen C. Take acetaminophen with food to reduce risk of liver damage D. Avoid taking any pain reliever other than acetaminophen
A. Limit intake of acetaminophen to less than 2000mg/day At risk for liver issues --> Max daily dose for liver caution is <2000mg/day
A conscious patient is admitted to the emergency department with an overdose of alprazolam. Which intervention should the nurse implement first? A. Prepare to administer an emetic with activated charcoal B. Request a mental health consultation for the patient C. Prepare to administer flumazenil D. Determine why the patient chose to overdose on the medication
A. Prepare to administer an emetic with activated charcoal
Which outcome is of greatest priority for asthma patients? A. Preventing airway inflammation B. Increasing exercise tolerance C. Stimulating release of eosinophils D. Avoid pollution
A. Preventing airway inflammation
Patient is prescribed codeine as an antitussive. Which symptom will nurse observe for as an adverse effect of this medication? A. Respiratory depression B. Increased HR C. Productive cough D. Restlessness
A. Respiratory depression Opioid product Naloxone for antidote
A patient with Parkinson's disease who is taking selegiline has had hip surgery and is being admitted to the orthopedic unit. Which postoperative order should the nurse question? A. Enoxaparin B. Meperidine C. Selegiline D. Cefazolin
B. Meperidine
Client who has history of MI is prescribed aspirin 325mg. Nurse recognizes that the aspirin is given due to which of the following actions of medication? A. Analgesic B. Anti-inflammatory C. Antiplatelet aggregate D. Antipyretic
C. Antiplatelet aggregate
Older patient with skin cancer and HTN prescribed levodopa/carbidopa to treat Parkinson's disease. Which action by nurse is best? A. Give medication if patients BP is normal B. Administer med as prescribed C. Ask patient about type of skin cancer D. Hold medication if patient is older than 65
C. Ask patient about type of skin cancer Levodopa can activate malignant melanoma
Which information should nurse include when teaching patient about inhaled glucocorticoids? A. Inhaled glucocorticoids have many significant adverse effects B. Principal side effects of inhaled glucocorticoids include hypertension and weight gain C. Use of spacer can minimize side effects D. Patients should rinse and spit before administering
C. Use of spacer can minimize side effects rinse and spit after not before
Patient is prescribed phenytoin [Dilantin] for epileptic seizures. Which of the following is the priority for patient teaching? A. Teach patient to adjust dose according to presence of symptoms B. Tell patient to take medication with meals C. Inform patient about prevention for gingival hyperplasia. D. Teach patient to avoid abrupt cessation of treatment
D. Teach patient to avoid abrupt cessation of treatment Abrupt D/C can lead to life threatening seizures
A post op patient who receives IV infusion of morphine has RR of 8bpm and is lethargic. Which PRN med should nurse administer to patient? A. methadone B. Nalbuphine C. Tramadol D. Naloxone
D. Naloxone
Nurse is caring for client who is taking aspirin for arthritis. Nurse should identify which of the following findings as an adverse effect of this medication? A. Tinnitus B. Clay colored stools C. Nystagmus D. Respiratory depression
A. Tinnitus The nurse should identify tinnitus, or ringing in the ears, as an adverse effect of aspirin that indicates salicylism.
Patient has been receiving long-term prednisone therapy for treatment of rheumatoid arthritis. Chart indicates that the patient has developed Cushing's syndrome. During assessment the nurse anticipates to find all but which manifestation of Cushing's syndrome? A. Hypoglycemia B. Muscle weakness C. Glucosuria D. Buffalo hump
A. Hypoglycemia Hyperglycemia, muscle weakness, glucosuria, and buffalo hump are expected findings for Cushing's.
Nurse prepares to administer lithium to a patient. Which lab result should first be assessed? A. Urinary creatinine clearance B. Serum troponin 1 and T levels C. Fasting blood glucose level D. Serum lipid profile
A. Urinary creatinine clearance Male sure patient can excrete appropriately to prevent toxicity d/t delayed or slowed excretion
Patient asks what medication would be most effective in treatment of seasonal hay fever. Nurse will teach patient about use of which drug? A. Azelastine [Astelin] B. Chlorpheniramine [Chlor-Trimeton] C. Fluticasone [Flonase] D. Pseudoephedrine [Sudafed]
C. Fluticasone [Flonase] Fluticasone is best medication to treat allergic rhinitis (hay fever)
Nurse cares for a patient who is receiving lithium. Which medication, if prescribed by HCP, should the nurse question? A. Levothyroxine [Synthroid] B. Sulindac [Clinoril] C. Furosemide [Lasix] D. Propranolol [Inderal]
C. Furosemide [Lasix] Diuretics promote Na loss --> increasing lithium plasma levels and risk lithium toxicity
Patient with depression has been prescribed Fluoxetine [Prozac]. Which statement made by patient indicates understanding of teaching? A. Disorientation and hallucinations are common B. The drug may enhance my interest in sex C. It may take 3-4 weeks before my mood is elevated D. I can stop this medication when I feel less depressed
C. It may take 3-4 weeks before my mood is elevated Half life prolonged --> takes several weeks to reach minimum therapeutic drug levels to achieve effect
Patient has been prescribed pharmacologic doses of glucocorticoids. It is most important for the nurse to teach the patient to do what? A. Increase intake of dietary Na B. Take Abx to prevent infection C. Never abruptly withdraw from therapy D. Have an eye exam every year
C. Never abruptly withdraw from therapy Can cause DEADLY adrenal insufficiency
Patient with acute gouty arthritis requests information on preferred drug to take to treat a painful flare-up. Nurse should recommend which medication? A. Allopurinol B. Febuxostat C. Probenecid D. Naproxen
D. Naproxen 1st line = NSAID 2nd line = glucocorticoid 3rd line = Colchicine
NSAIDs differ from aspirin in all but which way? A. They cause reversible inhibition of COX, so their effects decline as soon as their blood levels decline B. They can suppress platelet aggregation, but they are not used to prevent MI or stroke C. They increase risk of MI and stroke and therefore should be used in the lowest effective dosage for the shortest time possible D. They are safe to use in children with chickenpox or influenza
D. They are safe to use in children with chickenpox or influenza Do NOT give NSAIDs OR aspirin to children w/ active viral infection.
Why do second-generation H1 blockers cause less sedation then first-generation H1 blockers? A. They are less potent B. They bind reversibly to histamine receptors C. They are rapidly metabolized D. They do not cross the blood-brain-barrier
D. They do not cross the blood-brain-barrier
After surgery a patient has morphine prescribed for post op pain. It is most important for the nurse to make which assessment? A. RR B. HR C. Pain level D. Constipation
A. RR
Nurse is providing discharge teaching to a client who has bipolar disorder and will be discharged with a prescription for lithium. The nurse should teach the client that which of the following factors puts her at risk for lithium toxicity? A. Client runs 4 miles outdoors every afternoon B. Client drinks 2 liters of liquids daily C. Client eats 2-3gm of sodium-containing foods daily D. Client eats foods high in tyramine
A. Client runs 4 miles outdoors every afternoon Strenuous exercise in outdoor heat, which can lead to dehydration, puts the client at risk for lithium toxicity. Mild to moderate exercise will not lead to lithium toxicity, but if the client engages in strenuous exercise during hot weather, she should take care to replace any water and sodium that have been lost through profuse sweating. This also applies to other factors that can cause the client to become dehydrated, such as having diarrhea or taking diuretics.
Nurse is caring for a client who has severe manifestations of schizophrenia and is medicated PRN for agitation with haloperidol. Nurse should assess the client for which of the following adverse effects? A. Dysrhythmias B. Cataracts C. Pancreatitis D. Bleeding
A. Dysrhythmias Cardiac dysrhythmias are a risk for clients taking haloperidol and other conventional antipsychotic medications. The client should be monitored for changes in vital signs, tachycardia, and ECG changes, including prolonged QT interval, while taking haloperidol. There is a risk for cardiac arrest due to torsades de pointes.
An adult patient receives lidocaine by injection before procedure. Which finding indicated that patient is experiencing systemic reaction and toxicity? A. Mean arterial pressure of 75mmHg B. Temp of 100.8F (38.2C) C. HR of 42 BPM D. RR of 12 BPM
C. HR of 42 BPM Lidocaine systemic absorption --> look for cardiac toxicity,
Patient who is diagnosed with BPD is prescribed lithium. To monitor for lithium toxicity, the nurse should observe patient for what signs and symptoms? A. Insomnia, increased appetite, abdominal distention B. Dry cough, hyperactive reflexes, and HTN C. Polydipsia, slurred speech, and fine hand tremors D. Constipation, asterixis, and generalized edema
C. Polydipsia, slurred speech, and fine hand tremors
When teaching a patient about administration of tiotropium, the nurse should include which instruction? A. Use a spacer to increase the amount of drug delivered to the lungs and decrease the amount deposited in the throat B. Take 15 minutes before activities involving exertion or exposure to know allergens C. Swallow whole with a glass of water D. Do not use as a rescue inhaler
D. Do not use as a rescue inhaler
A patient is brought to the ED for treatment of OD on alprazolam [Xanax]. Which medication should the nurse prepare to administer to this patient? A. Protamine sulfate B. Acetylcysteine [Acetadote] C. Naloxone [Narcan] D. Flumazenil [Romazicon]
D. Flumazenil [Romazicon] Flumazenil = antidote for Benzodiazepine OD
Nurse in the emergency department is caring for a client who has acute toxicity from acetaminophen OD. Nurse should prepare to administer which of the following medications? A. Flumazenil B. Acetylcysteine C. Atropine D. Vitamin K
B. Acetylcysteine Acetylcysteine is the antidote for acetaminophen. It converts the toxic metabolite to a nontoxic form.
The nurse is administering allopurinol to a patient who also receives warfarin. Which laboratory test result would be a priority to report to the prescriber? A. eGFR 90 mL/min B. INR 4.6 C. BUN 15 mg/dL D. WBC 9200/mm3
B. INR 4.6
The nurse teaching the patient with allergic rhinitis that antihistamines are not effective in reducing which symptom? A. Nasal itching B. Stuffy nose C. Runny nose D. Sneezing
B. Stuffy nose
Which assessment finding in a patient who is prescribed a beta2 agonist would be a reason for the nurse to consult the prescriber? A. BP 140/90 mmHg B. Unexplained fainting C. Blood glucose 165 mg/dL D. Unexplained tremor
B. Unexplained fainting
A patient is admitted to the emergency department after a traumatic injury and is in severe pain from compound fractures. Which condition would be of greatest concern when administering an opioid? A. Diabetes B. Hypertension C. Head Injury D. Asthma
C. Head Injury
Nurse has administered a dose of salmeterol (Serevent Diskus) to a client. Client develops generalized rash and urticaria, and eyelids begin to swell. Which cation should nurse take? A. Apply lanolin-based cream to rash B. Encourage client to drink fluids quickly C. Assess clients vision with Snellen chart D. Call HCP immediately
D. Call HCP immediately
Cromolyn sodium is prescribed for client with allergic asthma. Nurse should plan care understanding the action of this medication: A. Dilate bronchi B. Increase number of eosinophils C. Promote migration of eosinophils into inflammatory site. D. Inhibit release of mediators from mast cells after exposure to an antigen
D. Inhibit release of mediators from mast cells after exposure to an antigen Cromolyn sodium is an anti-asthmatic, anti-inflammatory, and mast cell stabilizer. Can also interrupt migration of eosinophils to inflammatory site and decrease number of eosinophils. Used to decrease airway hyperresponsiveness which can sometimes occur in patients with asthma. No bronchodilating action
Which finding would be of most concern if the nurse is preparing to administer levodopa? A. Dizziness with position changes B. Tics C. Dark-colored urine D. Ataxia
A. Dizziness with position changes
A patient has been prescribed aspirin 325 mg once a day after angioplasty. It is important for the nurse to teach this patient to avoid using which over-the-counter (OTC) medications? A. Motrin (ibuprofen) B. Tylenol (acetaminophen) C. Robitussin (guaifenesin) D. TUMS (calcium carbonate)
A. Motrin (ibuprofen)
A nurse is reviewing laboratory tests of a patient receiving lithium carbonate for an acute episode of bipolar disorder. Which result should the nurse report to the prescriber immediately? A. Sodium 132 mEq/L B. Creatinine 2.7 mg/dL C. Potassium 4 mEq/L D. ALT 30 international units/L
B. Creatinine 2.7 mg/dL
The nurse is caring for a patient who has been diagnosed with panic disorder. Teaching should include which information? A. Symptoms usually only last 1-2 hours B. It is important to maintain adequate, regular sleep habits C. Avoid strenuous exercise because it increases anxiety D. Drug therapy helps the patient be more comfortable with situations and places he or she has been avoiding
B. It is important to maintain adequate, regular sleep habits
The nurse notes a respiratory rate of 14 breaths per minute when assessing an 18-month-old child with suspected salicylate poisoning. Which laboratory result would support this diagnosis? A. pH 7.35; PaCO2 37 mm Hg; HCO3 22 mEq/L B. pH 7.32; PaCO2 45 mm Hg; HCO3 20 mEq/L C. pH 7.41; PaCO2 35 mm Hg; HCO3 20 mEq/L D. pH 7.46; PaCO2 31 mm Hg; HCO3 18 mEq/L
B. pH 7.32; PaCO2 45 mm Hg; HCO3 20 mEq/L
What is a mechanism of action of an antiepileptic drug (AED)? (Select all that apply.) a. Block the actions of glutamate at NMDA and AMPA receptors b. Bind to sodium channels when they are in the inactive state c. Impair influx of calcium in axon terminals to prevent transmitter release d. Inhibit the action of the neurotransmitter GABA
a, b, c a. Block the actions of glutamate at NMDA and AMPA receptors b. Bind to sodium channels when they are in the inactive state c. Impair influx of calcium in axon terminals to prevent transmitter release
The following information was included in the change of shift report on a patient who is prescribed aspirin for its anticoagulant effects. Which patient symptom, if present, would be a priority for the nurse to report to the provider? A. Two liquid stools in the past 24 hours B. Abdominal bloating C. Heartburn when recumbent D. Emesis of dark brown particles
D. Emesis of dark brown particles
A 24-year-old female with bipolar disorder is prescribed valproic acid. Which question should the nurse ask the patient? A. "Have you ever had a migraine headache?" B. "Are you taking any type of birth control?" C. "When was the last time you had a seizure?" D. "How long since you have had a manic episode?"
B. "Are you taking any type of birth control?"
The nurse should be concerned about which finding in a patient on long-term, low-dose colchicine therapy to prevent gout? A. Platelet count of 200,000/mcL B. WBC of 6500 mm/3 C. Complaints of headache D. Complains of muscle pain and weakness
D. Complains of muscle pain and weakness
When planning interventions for pain control in a patient with gouty arthritis, the nurse should assess for pain in which joints? A. Neck B. Feet C. Hands D. Shoulders
B. Feet
A patient with cancer has been receiving increased doses of oxycodone for pain relief. Which teaching can help prevent the adverse effect that is most likely to persist with long-term use of this drug? A. Take deep breaths every hour B. Do not operate dangerous machinery C. Change positions slowly D. Consume adequate fluids and fiber
D. Consume adequate fluids and fiber
Case Study: 24yo woman has been diagnosed with BPD. Patient has order to receive lithium. 1. Before administering med it is appropriate for nurse to do what? 2. When providing patient teaching regarding lithium therapy what are some of the specifics the nurse should include related to this medication? 3. Patient tells the nurse she is afraid to take lithium because she has heard that she must have blood work done every day if she takes the medication and she doesn't like needles. What is a therapeutic response for the nurse to make?
1. Lithium plasma levels, Cardiac status, electrolytes (Na), renal function (BUN, Cr, GFR), thyroid function, pregnancy possible (F) 2. Take w/ meals or milk, take pills whole do not chew or crush, *take even when you are feeling well if possible have caregiver oversea medication Tx 3. Lithium plasma levels are monitored frequently and initiation of treatment (Q2-3 days) until dosing is stabilized, but then only need to get blood levels checked Q3-6 months after stabilized. It is important to monitor frequently at first d/t narrow therapeutic range and risk for toxicity. Once find proper dose, risk for toxicity is lower and periodic monitoring is adequate as long as medication is being taken appropriately and there are no symptoms/side effects of concern.
Charge nurse is teaching a group of nurses about the antagonist action of medications. Nurse should include in the teaching that which of the following antagonist medications is used for benzodiazepine? A. Flumazenil B. Diphenhydramine C. Protamine D. Naloxone
A. Flumazenil The nurse should teach that flumazenil is an antagonist that reverses the effects of benzodiazepines by recognition site on the GABA/benzodiazepine receptor complex.
Nurse is caring for a client who has a serum lithium level of 2.0. Which of the following is the priority action for the nurse to take? A. Notify primary provider the result indicates toxicity B. Continue to monitor expected maintenance level C. Request the provider increase client's medication dose D. Check the client for manifestations of hypernatremia
A. Notify primary provider the result indicates toxicity The therapeutic reference range for lithium is 0.8-1.4 mEq/L. The nurse should recognize the client could require hospitalization and report the finding to the provider. The nurse should check the client for findings associated with advanced to severe lithium toxicity like vision changes, neurological impairment, and hypotension.
Nurse prepares to administer memantine [Namenda] to a patient with severe AD. Nurse should assess what before administering the medication? A. Hgb and Hct B. BUN and serum Cr C. Aspartate aminotransferase and alanine aminotransferase D. ESR and neutrophil count
B. BUN and serum Cr Memantine is little metabolized by body and largely excreted through kidneys. Think "Meme needs her kidneys checked"
Which of the following statements by a client taking Montelukast should indicate need for further teaching? A. I will need to have my liver function checked B. I can take med w/ or w/o food C. I may be able to decrease the use of my MDI D. I will take medication when I first notice I am having trouble breathing
D. I will take medication when I first notice I am having trouble breathing Montelukast is not used for immediate relief because slow onset of effect (within 24hr of first dose and maintained with 1x daily dose in evening)
Nurse is teaching a client who takes acetaminophen daily to manage mild knee pain. Nurse should instruct the client to monitor for which of the following adverse reactions to this medication? A. Tinnitus B. Muscle pain C. Hyperglycemia D. Jaundice
D. Jaundice Acetaminophen can cause hepatotoxicity. The client should monitor and report jaundice, abdominal pain, clay colored stools, and fever.
Nurse is caring for a client who has opioid toxicity and has a respiratory rate of 6/min. Which of following medications should the nurse plan to administer? A. Epinephrine B. Protamine C. Flumazenil D. Naloxone
D. Naloxone The nurse should plan to administer naloxone, which is an opiate antagonist that competes with opioids at opiate receptor sites making the opioid ineffective.
Which statement is true regarding antihistamine administration to older adults? A. Antihistamines cause CNS excitation in older adults B. Larger doses of antihistamines are needed for older adults C. Antihistamines can be used to reduce intraocular pressure D. Older men with BPH can experience worse symptoms when taking antihistamines
D. Older men with BPH can experience worse symptoms when taking antihistamines Anyone with issues concerning urinary retention/hesitancy will be at higher risk/severity of UI Sx. Antihistamines can cause worsened CNS depression in older adults, they may need smaller doses, and they can make glaucoma worse.
Patient with mild symptoms of AD is prescribed donepezil [Aricept]. Which statement by patient indicates need for further teaching? A. This drug will improve transmission by neurons in my brain B. I may experience an upset stomach while taking this drug C. I will take this drug every night at bedtime with a snack D. The drug will stop damage to neurons in my brain
D. The drug will stop damage to neurons in my brain Donepezil will not stop the damage, there is no cure, but ideally it will help slow down the progression of damage to increase length and preserve quality of life.
Patient newly prescribed carbamazepine [Tegretol] for seizure control. It is most important for nurse to teach patient to avoid which food? A. Tomatoes B. Grapefruit juice C. Spinach D. Kiwi fruit
B. Grapefruit juice Inhibits metabolism and increases plasma levels of carbamazepine
When assessing a patient who is receiving an antidepressant, which question would be of greatest priority for the nurse to ask? A. "Have you had any difficulty voiding?" B. "Are you concerned about weight gain when you take medications?" C. "Are you having any thoughts of doing anything to harm yourself?" D. "Do you experience dizziness when you stand up?"
C. "Are you having any thoughts of doing anything to harm yourself?"
A patient is taking digoxin for heart failure (HF). The nurse should assess for what sign(s) / symptom(s) associated with toxicity? (Select all that apply.) a. Anorexia b. Flushed skin c. Positive Chvostek's sign d. Visual halos e. Muscle weakness
a, d, e a. Anorexia d. Visual halos e. Muscle weakness
Patients on long-term glucocorticoid therapy may decrease a common complication of therapy by having adequate servings of which foods in their diet? A. Dairy products B. Whole grains C. Broccoli and cauliflower D. Legumes
A. Dairy products
What is the nursing priority when administering a long-acting benzodiazepine as prescribed? A. Safety B. Respiratory depression C. Potential for abuse D. Gastric distress
A. Safety
Which statement indicates that the patient diagnosed with bipolar disorder who is taking lithium understands the medication teaching? A. "I will monitor my daily lithium level." B. "I will make sure I do not get dehydrated." C. "I need to taper the dose when I stop taking it." D. "I need to take the medication on an empty stomach."
B. "I will make sure I do not get dehydrated."
Nurse prepares to administer a cholinesterase inhibitor to a patient with AD. Which medication, if order by HCP, should nurse question? A. Famotidine [Pepcid] B. Amitriptyline [Elavil] C. Memantine [Namenda] D. Levothyroxine [Synthroid]
B. Amitriptyline [Elavil] Tricyclic antidepressants can decrease therapeutic effects of cholinesterase inhibitors.
Nurse teaches patient about bupropion [Wellbutrin] Which statement by patient indicates need for further teaching? A. I can take this drug with food to reduce nausea B. This drug will increase my interest in sex C. I may experience decreased appetite and weight loss D. I had a serious head injury 3 years ago
Bupropion [Wellbutrin] is generally well tolerated, but can cause seizures. Contraindicated if Hx of head trauma or seizures d/t increased risk of adverse seizures
A patient who experiences an attack of gout once every 1 or 2 years has been self-treating with over-the-counter (OTC) drugs. Which drug would the nurse expect to provide the least relief of gout pain? A. Naproxen (Aleve) B. Acetylsalicylic acid (Aspirin) C. Acetaminophen (Tylenol) D. Ibuprofen (Motrin)
C. Acetaminophen (Tylenol)
An elderly patient with Parkinson's disease has been prescribed carbidopa/levodopa. Which data indicates that the medication has been effective? The patient: A. has cogwheel motion when swinging the arms B. does not display emotions when discussing the illness C. is able to walk upright without stumbling D. eats 30-40% of meals
C. is able to walk upright without stumbling
A nurse is preparing a patient for surgery and is teaching the patient about the use of the patient-controlled analgesia pump. The patient voices concern about becoming addicted to morphine. What will the nurse do? A. Suggest that the patient use the PCA sparingly. B. Discuss possible nonopioid options for postoperative pain control. C. Tell the patient that the pump can be programmed for PRN dosing only. D. Ask the patient about any previous drug or alcohol abuse.
D. Ask the patient about any previous drug or alcohol abuse.
Nurse caring for patient who had extensive abdominal surgery 3 days ago. Morphine is being administered via PCA pump for pain control. What reversal agent should nurse have available and what is its action?
Naloxone. Reverses action of opioids Remember that this will also reverse the pain control effects as well. Patient will likely be in severe pain after naloxone admin.
On admission, the nurse is reviewing all of the drugs that a 78-year-old patient takes at home. The patient has a history of hypertension and diabetes. The patient takes OTC diphenhydramine when she has a cold. The nurse explains the effect of first-generation histamine blockers on the body and on a cold. Which statement, if made by the patient after the teaching, suggests a need for additional teaching? A. "Benadryl can make mucus from a cold hard to expel because it thickens mucus." B. "Benadryl does not prevent colds, but it can make my cold go away faster." C. "Benadryl can make my constipation worse." D. "My 3-year-old granddaughter could have convulsions if she took some of my benadryl."
B. "Benadryl does not prevent colds, but it can make my cold go away faster."
Nurse is providing dietary teaching for a client who has a new prescription for a monoamine oxidase inhibitor (MAOI). When the client develops a sample lunch menu, which of the following items requires intervention by the nurse? A. Glass of whole milk B. Celery sticks C. Bologna sandwich D. Sliced apples
C. Bologna sandwich Clients who are receiving an MAOI should avoid foods containing a high tyramine content. Bologna has a high tyramine content and should be avoided.
Which symptoms, if occurring after a patient has received a local anesthetic with epinephrine, is a priority to report to the prescriber? A. Respirations 24/minute B. Pulse 120 beats/min C. Temperature 38C (100.4 F) D. BP 100/60 mm Hg
B. Pulse 120 beats/min
A patient in labor requests a spinal anesthetic and has many questions. How should the nurse respond to the following: 1. "I want to be awake during the birth. Will I fall asleep after I have the spinal?" 2. "The anesthesiologist said there are some risks associated with spinal anesthesia and BP. Could you explain them?" 3. "If I were to get the adverse effect of spinal headache how would it be treated?"
1. She will not lose consciousness after spinal. Spinal anesthesia will affect areas of spine locally and will result in decreased pain but no decreased LOC 2. There is an associated hypotension risk but BP is monitored and anesthetic rate is adjusted accordingly. There is also less hypotension risk with local than with general 3. Headaches can occur 6-48hr after spinal anesthesia. If headache does occur - analgesic, increased fluid, sometimes caffeine is given. Sometimes blood patch is placed - blood injected into area to stop leakage that is causing headache
A patient is admitted with phenobarbital overdose. Which prescribed action would be of greatest priority? A. Obtain serum drug level B. Initiate seizure precautions C. Initiate IV fluids D. Assess vital signs
D. Assess vital signs
A patient diagnosed with pneumonia is admitted to the medical unit. The nurse notes the patient is taking an antidepressant medication. Which data best indicates that the antidepressant medication is effective? The patient: A. reports a "2" on a 1-10 scare, with 10 being very depressed B. reports not feeling very depressed today C. gets out of bed and completes ADLs D. eats 90% of all meals that are served during that shift
A. reports a "2" on a 1-10 scare, with 10 being very depressed
A patient diagnosed with obsessive-compulsive disorder is prescribed sertraline. Which statement indicates understanding of the medication teaching? A. "If I get a headache or become nauseated, I will notify my health care provider immediately." B. "It may take several weeks before I see a change in my behavior." C. "I need to be careful because SSRIs can cause physical addiction." D. "I am glad I do not need to go to my psychologist's appointments."
B. "It may take several weeks before I see a change in my behavior."
A nurse is teaching a group of nursing students about local anesthetics. Which statement by a student reflects an understanding of the teaching? A. "Local anesthetics do not cause systemic effects." B. "Local anesthetics affect motor and sensory neurons." C. "Local anesthetics do not block temperature receptions." D. "Local anesthetics affect large myelinated neurons first."
B. "Local anesthetics affect motor and sensory neurons."
Patient is prescribed celecoxib [Celebrex] and warfarin [Coumadin]. Nurse should monitor patient for what? A. Renal toxicity B. Bleeding C. Stroke Sx D. Dysrhythmias
B. Bleeding
Patient is diagnosed with T2DM and schizophrenia. Nurse will closely monitor the blood sugar if patient receives which med for treatment of schizophrenia? A. Loxapine [Loxitane] B. Clozapine [Clozaril] C. Thiothixene [Narvane] D. Haloperidol [Haldol]
B. Clozapine [Clozaril] 2nd gen antipsychotics (SGAs) cause increased risk for developing DM d/t increased risk of developing metabolic syndrome (increased weight, decreased activity)
It would be of greatest priority for the patient to report which adverse effect of valproic acid (Depakene)? A. Hair loss B. Belching C. Abdominal pain D. Weight gain
C. Abdominal pain
The nurse is preparing to administer alprazolam to a patient with generalized anxiety disorder. Which assessment should the nurse conduct prior to administering the medication? A. Apical pulse B. Respiratory rate C. Anxiety level D. Blood pressure
C. Anxiety level
Cocaine differs from ester-type local anesthetics in which way? A. It is known to cause physical dependence B. It produces CNS excitement, then depression C. It causes intense vasoconstriction D. It can be particularly dangerous if given to a patient with heart failure
C. It causes intense vasoconstriction
Which data should the nurse assess for the client with a seizure disorder taking valproate? A. BUN and creatinine B. WBC count C. Liver enzymes D. RBC count
C. Liver enzymes
The nurse is ambulating a postoperative patient in the hall who is receiving an opioid analgesic for pain. The patient complains of severe nausea. What is the priority nursing action at this time? A. Get an emesis basin B. Administer the prescribed antiemetic C. Walk the patient back to his room D. Assist the patient to sit down
D. Assist the patient to sit down
What is a realistic outcome for a patient receiving drug therapy for Parkinson's disease? A. Reversal of neurodegeneration B. Absence of tremor C. Normal gait D. Improved ability to perform ADLs
D. Improved ability to perform ADLs
Which would not be an appropriate reason for the nurse to administer an as-needed dose of 650mg of aspirin? A. Hand pain with stiffness when arising B. Knee pain with ambulation C. Right temporal headache associated with tense neck D. Right upper quadrant pain that intensifies with inspiration
D. Right upper quadrant pain that intensifies with inspiration
Nurse assess patient's RR to be 6 bpm. Nurse reviews order for naloxone: Admin 0.1mg naloxone PO for RR <8bpm. What is most appropriate response by nurse?
Question the order b/c naloxone is not administered PO. It can be IM, IV, SC, or Intranasal but never PO (slowest absorption and naloxone is a rescue med)
The patient admitted to the psychiatric unit for major depressive disorder with an attempted suicide is prescribed an antidepressant medication. Which interventions should the nurse implement? (Select all that apply.) a. Assess the patient's apical pulse and blood pressure b. Check the patient's serum antidepressant level c. Monitor liver function status d. Provide for and ensure the patient's safety e. Evaluate the effectiveness of the newly prescribed medication
a, c, d a. Assess the patient's apical pulse and blood pressure c. Monitor liver function status d. Provide for and ensure the patient's safety
Which are characteristics of drugs that are able to cross the blood-brain barrier? (Select all that apply). a. Water-soluble b. Highly ionized c. Lipid-soluble d. Move via transport systems e. Protein-bound
c, d, c. Lipid-soluble d. Move via transport systems
Nurse is caring for patient who is taking phenytoin [Dilantin]. Which medication, if ordered by physician, should the nurse question? A. Cimetidine [Tagamet] B. Captopril [Capoten] C. Pantoprazole [Protonix] D. Ondansetron [Zofran]
A. Cimetidine [Tagamet] Cimetidine can elevate phenytoin levels d/t it decreasing rate of metabolism of drug. Increased risk toxicity/adverse reaction
Client has begun using a methylxanthine bronchodilator. What beverage should patient avoid? A. Coffee B. Orange juice C. Mineral water D. Cranberry juice
A. Coffee Avoid xanthine containing foods
When evaluating an asthmatic client's knowledge of self care, nurse recognizes additional instruction needed when client makes which statement? A. I use my corticosteroid inhaler each time I feel SOB B. I see my doctor if I have an upper respiratory tract infection and always get a flu shot C. I use my bronchodilator inhaler before walking so i don't become SOB D. I use my bronchodilator inhaler before I visit places like the zoo because of my allergies.
A. I use my corticosteroid inhaler each time I feel SOB Albuterol is rescue inhaler. inhaled corticosteroid is to manage long-term persistent asthma.
Patient taking levodopa/carbidopa [Sinemet] for Parkinson disease experiences frequent "on-off" episodes (ie abrupt loss of effect). Which action by nurse is best? A. Administer med when patient has an empty stomach B. Instruct patient to avoid high-protein foods C. Have patient increase intake Vit B6 D. Discontinue drug for 10 days ("drug holiday")
B. Instruct patient to avoid high-protein foods Protein can decrease effectiveness of levodopa/carbidopa. Don't avoid protein altogether, but disperse is throughout day and avoid high protein meals.
Which are common symptoms of hypokalemia caused by glucocorticoids with high mineralocorticoid activity? A. Anxiety and flushed skin B. Muscle weakness and fatigue C. Hypotension and cool, clammy skin D. Tingling around the mouth and fingers
B. Muscle weakness and fatigue
Client taking albuterol by inhalation cannot cough up secretions. What should nurse suggest client do to assist in expectoration of secretions? A. Get more exercise each day B. Use dehumidifier in the home C. Drink increased amounts of fluids every day D. Take an extra dose of albuterol at bedtime
C. Drink increased amounts of fluids every day. Standard advice for patients receiving any adrenergic bronchodilators unless existing contraindicated health problem (on fluid restrict) Drink at least 2-3L per day to decrease viscosity and increase expectoration of secretions.
Patient who takes OTC diphenhydramine [Benadryl] for seasonal allergy symptoms complains about drowsiness. What should nurse do? A. Instruct patient to drink caffeinated beverages B. Recommend taking me with meals C. Ask patient's healthcare provider to prescribe hydroxyzine [Vistaril] D. Tell patient to take cetirizine [Zyrtec] instead of diphenhydramine
D. Tell patient to take cetirizine [Zyrtec] instead of diphenhydramine 2nd gen H1 antagonists cause less sedative effect than 1st gen H1 antagonists.
The nurse understands that the following are potential adverse effects of glucocorticoids. (Select all that apply.) a. Hypoglycemia b. Immunosuppression c. Peptic ulcers d. Adrenal hyperactivity e. Osteoporosis
b, c, e b. Immunosuppression c. Peptic ulcers e. Osteoporosis
A nurse is caring for a client who was admitted with acute psychosis and is being treated with haloperidol. The nurse should suspect that the client may be experiencing tardive dyskinesia when the client exhibits which of the following? (SATA) a. Urinary retention and constipation b. Tongue thrusting and lip smacking c. Fine tremors and pill rolling d. Facial grimacing and eye blinking e. Involuntary pelvic rocking and hip thrusting movements
b, d, e b. Tongue thrusting and lip smacking d. Facial grimacing and eye blinking e. Involuntary pelvic rocking and hip thrusting movements
A nurse is teaching a client about adverse effects of zolpidem. Which of the following adverse effects should the nurse include in the teaching? A. Daytime sleepiness B. Night time sweating C. Change in taste D. Double vision
A. Daytime sleepiness Daytime drowsiness and sedation are adverse effects of zolpidem.
Nurse is caring for client who has bipolar disorder and has been taking lithium for 1 year. Before administering the medication, the nurse should check to see that which of the following tests have been completed? A. Thyroid hormone assay B. Liver function test C. Erythrocyte sedimentation rate D. Brain natriuretic peptide
A. Thyroid hormone assay Thyroid testing is important because long-term use of lithium may lead to thyroid dysfunction. LFTs must be monitored before and during valproic acid therapy, not lithium therapy
A patient's peak expiratory flow rate has been around 70% of his personal best despite regular and as-needed use of drugs. What are current treatment recommendations for this patient? A. Use rescue inhaler and consult prescriber for possible treatment changes B. Continue regularly prescribed treatment C. Seek immediate emergency medical attention D. Use rescue inhaler and continue regularly prescribed treatment
A. Use rescue inhaler and consult prescriber for possible treatment changes
Patient is prescribed Allopurinol for chronic topaceous gout. Patient develops rash. What is priority intervention by the nurse? A. Stop medication and assess for liver and kidney failure B. Instruct patient to avoid exposing the skin to sunlight C. Administer diphenhydramine with dose of allopurinol D. Monitor the patient for respiratory depression
A. Stop medication and assess for liver and kidney failure Sensitivity reaction can lead to hepatic/renal toxicity or failure.
A patient with asthma is prescribed albuterol 2 buffs 3x daily. Nurse should teach patient to do what? A. Rinse mouth after taking prescribed dose B. Take an extra dose if breathing compromised C. Wait 1 min between puffs from inhaler D> Take adequate amounts vitamin D and calcium
C. Wait 1 min between puffs from inhaler Waiting b/w puffs can reduce side effects of shakiness/tremors Rinsing mouth is inhaled steroids, calcium and Vit D is for any steroids. Should seek medical care and not take extra dose --> extra dose increases risk for cardiac toxicity.
Nurse is about to administer Albuterol (Ventolin HFA) 2 puff and Budesonide (Pulmicort Turbohaler) 2 puff by metered dose inhaler (MDI). Nurse plans to administer by: A. Alternating with single puff each, starting with albuterol B. Alternating with single puff each, starting with budesonide C. Budesonide inhaler first then albuterol D. Albuterol inhaler first then budesonide.
D. Albuterol inhaler first then budesonide. Albuterol bronchodilates --> widened airway to allow corticosteroid inhaler to be more effective.
A patient with BPD is prescribed lithium. Which statement, if made by patient, indicates need for further teaching? A. I can take the medication with milk or a snack B. I will call my doctor if I feel hyperactive C. I should drink at least 8-10 glasses of water every day D. I will reduce my salt intake while taking this medication
D. I will reduce my salt intake while taking this medication Do NOT change Na intake. Keep consistent while taking lithium. Increased Na = decreased lithium effect Decreased Na = Increased lithium effect Decreased Na is more risky than increased Na d/t increased risk for lithium toxicity
Which statements are true about the common cold? (Select all that apply.) a. Antibiotics are not effective b. Fever means there is a bacterial infection c. Vitamin C prevents colds d. It is best treated with multiple symptom medications e. Cold remedies should be avoided in children up to 6 years of age
a, e a. Antibiotics are not effective e. Cold remedies should be avoided in children up to 6 years of age
Topical local anesthetic should be applied in what way? (Select all that apply.) a. As a thick film over the entire affected area b. Followed by heat to increase absorption c. Only to the affected area d. Using the lowest effective dose e. Gently to areas of skin that are abraded
c, d c. Only to the affected area d. Using the lowest effective dose
nurse preparing to administer albuterol to a client. Which parameters should the nurse assess before and during therapy? A. Nausea and vomiting B. Headache and LOC C. Lung sounds and presence of dyspnea D. Urine output and BUN level
C. Lung sounds and presence of dyspnea Also assess pulse, BP, and color/character/amount of sputum (if production)
Patient with systemic lupus erythematosus is prescribed prednisone. It is most important for the nurse to monitor the patient for what? A. Hypotension B. Elevated K levels C. Neck and back pain D. Hypoglycemia
C. Neck and back pain vertebral compression from osteoporosis (osteoporosis risk from long-term prednisone therapy) Other risks are HTN, hyperglycemia, and low K levels
Which manifestation does the nurse associate with tardive dyskinesia? A. Pacing, squirming, with an uncontrollable need for motion B. Mask-like face with drooling, tremors, and shuffling gait C. Twisting, worm-like movements of tongue and face D. Sudden high fever, sweating, and BP fluctuations
C. Twisting, worm-like movements of tongue and face
Nurse reviewing abnormal lab values for 4 clients who have schizophrenia and take clozapine. For which of the following clients should nurse withhold medication and notify provider immediately to have clozapine therapy discontinued? A. Client who has WBC of 2,900 B. Client who has Hct of 55% C. Client who has serum K of 3.3 D. Client who has BUN of 22
A. Client who has WBC of 2,900 white blood cell count of 2,900 cells/mm3 is below the normal reference range of 5000 to 10000 cells/mm3 . The client who takes clozapine is at risk for agranulocytosis; therefore, a client who has a WBC of less than 3000 mm3 should have clozapine withheld and treatment stopped until the WBC returns to normal. Clozapine should be permanently stopped if a client's WBC falls below 2000 mm3.
Nurse is teaching a client who has a new prescription for diazepam. Which of the following information should the nurse include in the teaching? A. Diazepam can cause drowsiness B. This medication must be swallowed whole C. It is important to avoid foods that contain tyramine D. Grapefruit juice inactivates this medication
A. Diazepam can cause drowsiness Diazepam has sedative properties, so the client should not engage in potentially hazardous activities after receiving diazepam.
A client is prescribed Guaifenesin (Mucinex). Nurse determines client understands proper administration of medication if client states they will: A. Drink extra fluids while taking this medication. B. Take medication with meals only C. Take an additional dose once fever and cough persist. D. Limit PO fluid intake
A. Drink extra fluids while taking this medication Guaifenesin is an expectorate. Drinking extra fluids will help loosen secretions --> helps Mucinex excrete those secretions from airway
Patient has chronic idiopathic urticaria. What medication would be appropriate for nurse to administer for this condition? A. Fexofenadine [Allegra] B. Loratadine [Claritin] C. Azelastine [Astelin] D. Diphenhydramine [Benadryl]
A. Fexofenadine [Allegra] Fexofenadine and Cetirizine are the 2 meds used to treat CHRONIC urticaria. Diphenhydramine is used to treat ACUTE
An adolescent with asthma has controlled her asthma using a drug regimen that includes theophylline. Which new behavior would be of greatest priority to report to the prescriber? A. Occasionally skipping school when not ill B. Smoking a pack of cigarettes per day C. Joining the soccer team D. Becoming sexually active
B. Smoking a pack of cigarettes per day
Nurse is modifying diet of client who has Parkinson's disease and is prescribed selegiline, an MAOI. Which of the following foods should the nurse eliminate? A. Fresh fish B. Cheddar cheese C. Cherries D. Chicken
B. Cheddar cheese The nurse should eliminate aged cheeses from the diet of a client who is prescribed selegiline. Cheddar cheese contains tyramine, which can cause a hypertensive crisis.
Nurse is teaching a client who is taking benztropine to treat Parkinson's disease. Nurse should instruct client to report which of following adverse effect? A. Excess salivation B. Difficulty voiding C. Diarrhea D. Slow pulse
B. Difficulty voiding The nurse should instruct the client to report difficulty voiding, which may indicate urinary retention, as an adverse effect of benztropine. Benztropine is an anticholinergic medication that helps decrease the rigidity and tremors of Parkinson's disease.
Nurse is administering dose morphine sulfate to client via epidural cath after nephrectomy. Before administering med what should nurse plan to do? A. Place HOB flat B. Ensure naloxone is readily available C. Flush cath with 6mL sterile water D. Aspirate with syringe to ensure presence of cerebrospinal fluid (CSF) return.
B. Ensure naloxone is readily available Naloxone is antidote for opioids and can reverse resp depression. Epidural analgesia is used for patients with expected high levels of post op pain. Before admin check level of sedation, make sure HOB elevated 30 degrees (unless contraindicated). Want to aspirate with syringe to make sure NO CSF return. If CSF return --> cath moved from epidural space to subarachnoid space. Don't flush with water.
Nurse prepares to administer first dose of an antipsychotic agent to a patient. One hour after administration, it is most important for the nurse to assess what? A. Range of motion of UEs and LEs B. Orthostatic BP measurements C. Abdomen for distention and bowel sounds D. Tympanic membrane with otoscope
B. Orthostatic BP measurements Antipsychotics can cause orthostatic hypotension
Nurse is teaching client who has new prescription for ibuprofen to treat hip pain. Which of following instructions should nurse include in teaching? A. Expect ringing in your ears B. Take medication with food C. Store medication in refrigerator D. Monitor for weight loss
B. Take medication with food To minimize gastric irritation, the client should take ibuprofen with food or immediately after a meal.
It would be a priority to report which laboratory test to the prescriber if a patient is receiving therapeutic doses of glucocorticoids? A. BUN 20 mg/dL B. WBC 2000/mm3 C. Hgb A1c 5.9% D. ALT 30 international units/L
B. WBC 2000/mm3
Nurse is teaching client who has bipolar disorder and a prescription for lithium to recognize the manifestations of toxicity. Which of the following statements by the client indicates an understanding of the teaching? A. "I will report any loss of appetite." B. "Increased flatulence is an indication of toxicity." C. "Vomiting is an indication of toxicity." D. "I will call my provider if I experience any headaches."
C. "Vomiting is an indication of toxicity." Since vomiting and diarrhea are early signs of lithium toxicity, the client should omit the next dose of lithium and call the provider.
Which patient would be at highest risk for systemic toxicity from topical administration of a local anesthetic? A. 42yo patient who received epinephrine with local anesthetic B. 72yo who receives local anesthetic topically applied to intact skin C. 58yo who receives local anesthetic to 10cmx20cm abrasion D. 34yo given an injection of bupivacaine as a nerve block
C. 58yo who receives local anesthetic to 10cmx20cm abrasion large open wound --> larger surface area for local anesthetic to enter the bloodstream and become more systemically absorbed. Larger area also = larger amount of cream. Epi adjunct can actually decrease risk toxicity.
Nurse is reviewing medical record of client who reports drinking three to four glasses of wine each night and taking 3000mg of acetaminophen daily. Which of the following laboratory values is the priority for the nurse to assess? A. Amylase B. Creatinine C. Aspartate aminotransferase (AST) D. Antidiuretic hormone (ADH)
C. Aspartate aminotransferase (AST) The greatest risk to this client is liver injury from the combined adverse effects of alcohol and acetaminophen. Therefore, the priority laboratory value for the nurse to evaluate is AST because an elevated level is an indication of liver damage.
Nurse is assessing client who has been taking sertraline for 2 weeks. Nurse should identify which of the following findings as an indication that medication is effective? A. Client's BP is within expected reference range B. Client reports recent weight loss C. Client reports increase in mood D. Client's legs are not swollen
C. Client reports increase in mood
Client who experiences allergic rhinitis asks nurse about nasal corticosteroid. How should nurse reply? A. "Clear nasal passages after use" B. "Take only as needed" C. "Medication should start working immediately" D. "Medication works locally and decreases inflammation"
D. "Medication works locally and decreases inflammation" intranasal corticosteroids can be used to treat allergic rhinitis and it works locally to decrease inflammation rather than systemic corticosteroids (PO). Should clear BEFORE use, not after. Take regularly as prescribed for effect to be achieved. takes several days for maximal effect. Steroids must be continuous
Client with an exacerbation of chronic obstructive pulmonary disease has been on PO glucocorticoids and is currently being weaned to fluticasone by inhalation. Nurse determines client understands potential adverse effect to watch for during this medication change when client states the need to report which signs and symptoms? A. Chills, fever, and generalized rash B. Vomiting, diarrhea, and increased thirst C. Blurred vision, headache, and insomnia D. Anorexia, nausea, weakness, and fatigue
D. Anorexia, nausea, weakness, and fatigue Steroids... think endocrine. When transferring from PO (systemic) to nasal (local) steroids, patients are at risk for adrenal insufficiency. hypotension, hypoglycemia, anorexia, nausea, weakness, and fatigue
Nurse is caring for a patient with social anxiety disorder. Patient is currently experiencing intense anxiety. Nurse should prepare to administer which medication for the immediate relief of anxiety? A. Fluvoxamine [Luvox] B. Paroxetine [Paxil] C. Sertraline [Zoloft] D. Clonazepam [Klonopin]
D. Clonazepam [Klonopin] benzodiazepines provide IMMEDIATE relief anxiety, so best med choice for ACUTE anxiety Other options all take weeks-months to take effect, so would not be beneficial for acute relief.
Nurse giving med teaching to client receiving theophylline. Nurse instruct the client to limit intake of what? A. Apple and banana B. Yogurt and cheese C. Tuna and oysters D. Cola and chocolate
D. Cola and chocolate Theophylline is a methyl-xanthine bronchodilator. Teach patient to limit intake xanthine containing foods (coffee, cola, chocolate)
